Cholestasis of Pregnancy - any advice about *how* to deliver??
I am pregnant with our third kid -- just saw the documentary a few months ago and really wished I had seen it several years ago before my first two were born. But I *DID* at least have a doula and a midwife (although I was induced in the hospital both times)... and had two healthy boys -- who happen to have Autism. I am SUPER proud that I had no pain medication what-so-ever! But definitely bummed that I was given pitocin after seeing the documentary.
I was REALLY hoping this time around to use a birthing center. I found a great one, went to my first appt. and then the itching started... My midwife told me to see their OB-GYN who is their back-up in case of any serious issues. I had blood work done and was diagnosed with Cholestasis of Pregnancy (something 1 in 2,000 women get). I never had it in my previous pregnancies... and the big issue is that you have to have the baby early to avoid having a stillborn baby. I have been seeing a perinatal doc as well, who has said I will need to be induced at 35-36 weeks. Anyway, I was thinking -- what's worse, pitocin again?? Or having a C-section. As much as I want to avoid pitocin, I think I will have to go that route compared to having major surgery with a c-section. Any thoughts??
Also, the specialist says having a c-section will not allow the fluid in the baby's lungs to be pushed out like it would if the baby is delivered vaginally... and right away jumped on the bandwagon that nothing is wrong with pitocin. Yeah, nothing was wrong with eating fish containing Mercury a while back -- and now it's an issue. I am all about erring on the side of caution. I want the best for my unborn baby... I can deal with surgery, just as I can be a trooper and deal with being induced. I just can't seem to find much comparing the two ways of having the baby since this is a rare circumstance. As much as I want to do the birthing center route, the birthing center will not allow me to because they won't deliver babies before 36 weeks.
I was REALLY hoping this time around to use a birthing center. I found a great one, went to my first appt. and then the itching started... My midwife told me to see their OB-GYN who is their back-up in case of any serious issues. I had blood work done and was diagnosed with Cholestasis of Pregnancy (something 1 in 2,000 women get). I never had it in my previous pregnancies... and the big issue is that you have to have the baby early to avoid having a stillborn baby. I have been seeing a perinatal doc as well, who has said I will need to be induced at 35-36 weeks. Anyway, I was thinking -- what's worse, pitocin again?? Or having a C-section. As much as I want to avoid pitocin, I think I will have to go that route compared to having major surgery with a c-section. Any thoughts??
Also, the specialist says having a c-section will not allow the fluid in the baby's lungs to be pushed out like it would if the baby is delivered vaginally... and right away jumped on the bandwagon that nothing is wrong with pitocin. Yeah, nothing was wrong with eating fish containing Mercury a while back -- and now it's an issue. I am all about erring on the side of caution. I want the best for my unborn baby... I can deal with surgery, just as I can be a trooper and deal with being induced. I just can't seem to find much comparing the two ways of having the baby since this is a rare circumstance. As much as I want to do the birthing center route, the birthing center will not allow me to because they won't deliver babies before 36 weeks.
Tags: Autism, Cholestasis, Pregnancy, c-section, induce, induced, inducing, itchiness, itching, itchy, More…
Replies to This Discussion
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Permalink Reply by Rachel on -
vaginal birth is definately better. There are risks involved with c-sections also. Including respiratory complications for babies, hemmorraging, etc. If you have to use pitocin, see if you can ripen your cervix first with another medication or natural methods. Luckily, it's a third child which makes the whole induction thing better. What you can do is ask them to decrease or turn off the pitocin once you get into active labor (4-5 cm with a changing cervix). Some studies have shown that once a woman is in active labor, turning of the pit might be an option and their own bodies will kick in. Also, have them do low dose pit rather than high dose. This gives baby a better chance of adjusting. And avoid an epidural which might slow down labor. Also keep in mind that you may still need a c-section if the induction doesn't work. But I would go the induction route first and then see what happens. Good luck.
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Permalink Reply by Erin Mallants Rodriguez on -
Thank you so much! Great advice! My doula recommended the same thing with them ripening my cervix (and luckily my doc had suggested that, too). I'm going to print that info. and pass it along. Really appreciate the help!
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Permalink Reply by Kayla Dolan on -
On board with the induction. I would suggest that you try to go it without pain meds, because it will increase your likelihood of success. However, you will likely be bed-bound on monitors, because of your high-risk status and the use of pitocin. Both would require continuous fetal monitoring.
Good luck to you!
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Permalink Reply by Rachel on
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Just a note...just because you are on monitors, doesn't mean you have to stay in bed. Many units have telemetry monitors so you can walk around, but even if they don't, you can get up and walk with regular monitors, just not as far. Just make sure you stick to your guns with that one. I have worked with women on monitors and have had them in all sorts of positions, including hands and knees, squatting, up and moving etc.
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Permalink Reply by Sara on -
I was induced with Pit for my last baby and I was never restricted to the bed. They knew I didn't want any pain meds and as long as they got a good reading of baby's hb every hour or so, they were ok with my moving around as much as I needed/ wanted to. Do what you need to to stay comfortable and if they say you need to stay in bed, ask about just staying hooked to the monitors but out of bed in a chair, on a ball, or just standing. Hope your delivery goes well!
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Permalink Reply by Katie on -
I understand the dilemma you're facing--there certainly is a "theory" floating around regarding elective inductions with Pitocin and the risk of Autism. The theorists postulate that the artificial oxytocin may interfere with some babies' ability to produce/process natural oxytocin correctly. And since studies have shown that some autistic children have lower levels of oxytocin production in the brain, of course the worry is that early and aggressive exposure to Pitocin in utero may cause problems with natural production down the road in genetically susceptible children. Whew!
Since no randomized controlled trials have been performed (an entirely different argument is "Why not?"), we don't really know if elective inductions are truly one of the reasons for flourishing Autism rates. Dr. Michel Odent, a leader in the Birth Psychology field, has written some interesting articles on this theory. Here is a link to one: http://birthpsychology.com/primalhealth/primal12.html
Don't forget: You are an intelligent, well-informed mother who WILL make the right decision for her delivery. Regardless of which path you choose, I wish you a beautiful birth experience and a healthy, happy baby.
Best to you and your family!
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Permalink Reply by Wendy Robertson on -
I don't know anything about this particular issue/complication, however, is there any possible way to be on a monitor, perhaps a telemetry unit(cordless kind) around 35 weeks, to watch and see how the baby is doing all the time (have a unit at home? or have intermittent monitoring around the clock at home with a dopler or something)? If you oculd at least get to 36 weeks then would you still have the possibility of birthing at the birthing center? or does induction take that option away altogether? Is it possible to attempt induction by using more natural means to help things get going? just some thoughts running through my head. Best of luck to you.
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Permalink Reply by Rachel on
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You have to birth in a hospital if you are induced with pitocin and you should be monitored...the problem with pitocin is that it can cause contractions that are too strong so you need to monitor to make sure baby is dealing ok with the pitocin. You can try nipple stimulation for induction, but I doubt it would work that early...your body usually isn't ready then.
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Permalink Reply by Jennifer C on -
I was induced with my son in a birth center with an enema. Now this was NOT pleasant and I don't recommend doing it if you don't have to, but since you have to be induced maybe you could try that route at the birth center once you are 36 weeks. Btw, the contractions started almost immediately. They had first tried nipple stimulation and that did not work. Then they tried the enema and it worked right away. It would be best for them to use a prostiglandin first since your cervix needs to be ripe in order for any induction to work. This might help you avoid pit and still get to birth in the birthing center.
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Permalink Reply by Vanessa Manz on
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How high are your serum bile acid levels? Medscape has this article:
http://www.medscape.com/viewarticle/551031_5
Which says:
According to the largest observational study of women with ICP conducted to date, expectant management is a plausible option and offers the best maternal and fetal outcomes[4] for women with mild cases of ICP who have serum bile acid levels <40 mmol/L. Glantz et al. conducted a prospective cohort study of 693 women who were diagnosed with ICP. Fetal complications were not observed in women who had serum bile acids <40 mmol/L.[4] In the studies that have reported ICP management protocols, the timing of delivery with expectant management ranged from 38 weeks until the onset of spontaneous labor. Maternal laboratory and fetal monitoring occurs more frequently after 40 weeks, but varied from study to study.[
The bolding is mine. I personally would question a care provider who recommended induction or cesarean birth prior to 37 weeks as "evidence-based care" if levels are below 40mmol/L.
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